I am often asked by patients about the most optimal way to fix what is already broken. Even older patients who have been seeing other dentists for years may not always know their restorative options. I always try to recommend the most conservative approach. My goal is to remove as little of the tooth structure as possible while giving a patient a most stable and long-lasting restorative option. What are some of the options available today?
Here is a list from the most traditional and inexpensive to more sophisticated and pricey options.
1. Amalgam filling – this restoration was traditionally done before white fillings appeared in 1980s. The material is made of impure metals with mercury. The material itself is strong however it does not chemically bond to the tooth so it does not provide maximum support.
Pros – inexpensive and covered by most insurances
Cons – unsightly, can cause staining of cheeks and tongue (amalgam tattoo), contains mercury which has become a controversial ingredient in the last decade
Many dentists (myself included) do not offer amalgam restorations in their practice. While amalgam restorations may be considered medically acceptable, they are not considered material of choice.
2. Composite resin – white filling. This material has more elasticity than amalgam and chemically bonds to the tooth. It resembles a tooth in color and overall appearance. I recommend this material for small to medium fillings as well as for restorations of chipped front teeth. This material comes in different consistencies…for a back tooth, I use a thicker composite which is stronger but less polishable. For a front tooth, it’s best to use a slightly thinner composite as it can be polished to a more smooth and shiny appearance.
Pros – blends with the tooth, no metal or mercury
Cons – more expensive, used for smaller restorations
3. Porcelain filling (inlays/onlay) – this is a filling made of porcelain. It’s very strong, looks great, and can last a very long time. I do these when a substantial amount of tooth has been lost. Porcelain comes in different shades to match the tooth color precisely and also in various degrees of strength.
Pros – attractive, strong, long-lasting
Cons – more expensive, requires two visits
4. Porcelain crown or metal/porcelain crown – a porcelain crown is made entirely of white material. A metal porcelain crown will have a metal shell and white material on the outside. This is the restoration of choice when the walls of the tooth have been compromised with decay or after the tooth received root canal treatment.
Pros – attractive, full coverage and maximum support, long-lasting
Cons – Higher cost, insurances typically cover metal/porcelain crowns and not at 100%, requires more than one visit
These are some of the restorations your dentist may offer depending on medical necessity and financial considerations.
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